Moving beyond shame and stigma

Injecting-related injury and disease part 2

Frontline workers such as those in Needle and Syringe Programs play a critical role in reducing the harms associated with injecting-related injuries and disease (IRID). It can, however, be hard for front-line workers to know how to engage with clients about IRIDs, especially when there are other important things to address such as blood-borne viruses. (You can read more about the technicalities of IRIDs in the part 1 article in this edition of the Anex Bulletin).

Kevin Winder

Kevin Winder from peer-based Harm Reduction WA says that it’s important that staff treat clients first and foremost as a health consumer.

“The clients are accessing a health service, the same as someone with diabetes or a broken leg, and they should be provided with the same level of service,” Kevin says.

“One thing that really stops people who inject drugs from accessing health services is worrying about how they will be treated by service staff, especially if they’re presenting with scars, track marks, vein damage or abscesses. There is a lot of embarrassment that comes with that.

“That embarrassment and those negative reactions from health workers – which is quite a common experience – really drive that lack of engagement with mainstream health services.”

Sarah Larney from the National Drug and Alcohol Research Centre agrees, saying that stigmatising responses from frontline or medical staff can have a negative impact on people’s wellbeing.

“People can experience a lot of shame about IRIDs. So, for example, if abscesses are left untreated, they can actually start to smell, which is quite distressing for a person, but they still might not present for treatment if they anticipate a negative reaction from doctors or nursing staff,” Sarah says.

While some clients may have significant health problems (both injecting-related and otherwise), Kevin says that it was important not to overload clients with information: “You choose your battles”.

“It could well be that someone is clearly in ill health or has got lots of injecting-related injuries that are visible but they are really reluctant to access services. If you overload them or try to push them into treatment, you’re just going to drive them away,” he says.

“So, we really try to target the interventions for each client on a given day. You go for the thing that’s putting them at the most risk of harm, and try to reduce that level of risk.”